Surgical and radiological significance of variants of Bühler's anastomotic artery: a report of three cases.

Arterial anastomoses between the celiac trunk (CT) and superior mesenteric artery (SMA) include three variants. 1) The main anastomosis is the gastroduodenal artery (GDA), which is an important branch of the common hepatic artery and anastomoses with branches of the inferior pancreatic duodenal artery, a branch of the SMA. 2) The dorsal pancreatic artery (DPA) is usually a branch of the splenic artery, which anastomoses with the anterior and posterior pancreaticoduodenal arcades via a right transverse branch of the DPA (Kirk's arcade). 3) A less well known and rarely reported arterial anastomosis between the CT and SMA described by Buhler (1904). Three patients in whom variants of this anastomosis were present on retrospective analysis of three hundred consecutive combined CT and SMA arteriograms are reported. The embryological basis of its development, the surgical and radiological significance of the anastomotic artery are discussed.